The emergence of dangerous drug cocktails like purple drank in the 1990s highlighted their potential for misuse. Today, cough medicines with codeine are classified as Schedule V drugs, making them legal only with a prescription. Also known as: Sizzurp, purple stuff, lean, drank, barre, Texas tea, Tsikuni, purple jelly, Memphis mud, and purple Sprite. Drug class: The primary drug ingredient in purple drank is codeine, which is classified as an opioid. Promethazine, another drug in the cocktail, is an antihistamine. Common side effects: Euphoria, nausea, dizziness, impaired vision, memory loss, hallucinations, and seizures.
What Does Purple Drank Do?
People typically sip purple drank to experience euphoria and dissociation from one’s body. It’s often called a “swooning euphoria,” since promethazine acts as a sedative, and codeine creates a feeling of euphoria. These effects last between three to six hours. Purple drank also goes by the name “lean” because, similar to being very drunk, people often have to lean on something to stand up once the effects take place.
What the Experts Say
Purple drank became popular partly due to the glamorization of the cocktail and its euphoric effects among many celebrities and in numerous hip hop songs and videos. It’s responsible for the hospitalization and deaths of many people, including several celebrity singers, rappers, and professional athletes. For example, the singer and rapper Mac Miller, who later died of a drug overdose, had spoken about his addiction to purple drank. However, use of purple drank is not confined to any specific group, as American media erroneously reported when it first emerged. It’s unclear how many people misuse prescription cough syrups in the form of drug cocktails like purple drank. However, researchers know that many teens turn to cough and cold medication to get high, including 2.8% of 8th graders, 3.3% of 10th graders, and 3.4% of 12th graders, according to The 2018 Monitoring the Future Report from the University of Michigan.
Preventative Measures
In 2014, pharmaceutical company Actavis stopped producing and selling its prescription-only promethazine-codeine syrup product (nicknamed “Prometh”) due to the rise in recreational use. This move did not deter its use, however. In fact, people reportedly stockpiled the promethazine-codeine cough syrup and developed other drank recipes and preparation methods. For example, drank can be brewed from over-the-counter cough syrups containing dextromethorphan (DXM), which is similar to the dissociative anesthetics ketamine (Special K) and phencyclidine (PCP). Like these, when taken in excess, DXM can cause hallucinations and out-of-body (dissociative) experiences. It also causes adverse effects like increased heart rate, hypertension, and diaphoresis (profuse sweating). One recent variation is marijuana-infused sizzurp. The combined depressant effects of codeine and marijuana (THC) can be pronounced and dangerous. Research also points to increased symptoms of depression and anxiety in those who consume this mixture.
Common Side Effects
Because there is no way to know the soda-to-syrup ratio in any given serving, overdose risk is high with drug cocktails like purple drank. Each ingredient is associated with various side effects.
Promethazine
When used as prescribed, promethazine acts as an antihistamine, antiemetic (anti-vomiting), and sedative. Alone, promethazine doesn’t usually cause euphoria unless mixed with other depressants like codeine and alcohol as in mixtures like purple drank. When taken in large doses, promethazine can cause:
Abnormal heart rhythmChanges in blood pressureDry skin and mucous membranesHallucinationsSeizuresSevere breathing problems
Codeine
Codeine is a drug that is metabolized by the body into morphine. In prescription cough syrup, codeine works to suppress a cough. Morphine and other opioids can also cause feelings of elation, analgesia, and euphoria as well as dangerous side effects, including:
Brain damageDizzinessRedness of the arms, face, neck, and upper chestShortness of breathStopping of the heart
Depressants
Purple drank is composed of multiple depressants which can synergize to cause:
ComaHypotension (dangerously low blood pressure)Respiratory depressionSomnolence (sleepiness)StuporSudden death
When other central nervous depressants are thrown into the mix—like barbiturates, narcotics, and tricyclic antidepressants—repercussions are particularly grim. From a scientific perspective, it’s difficult to pinpoint exactly how much purple drank it takes to kill someone. From a medical perspective, it’s safe to say that imbibing any amount of purple drank is dangerous.
Signs of Use
Beyond finding empty bottles of cough syrup, styrofoam cups, soda, and candy among your loved one’s belongings, it’s important to watch out for any changes in personality and behavior. Changes might include being irritable, changes in sleep patterns, a loss of interest in school or social activities, or a sudden change in friends.
Commercial Products
A number of commercial products have emerged that are inspired by purple drank and include herbal ingredients such as melatonin, rose hips, and valerian. These products are often marketed as relaxation aids and sometimes use similar-sounding names such as “Lean” or “Purple Stuff.” Such products have been criticized for serving as a potential “gateway” to illicit drug use.
Bluish-colored fingernails and lipsBreathing problems (slow and labored breathing, shallow breathing, no breathing)Cold, clammy skinComaConfusionDizzinessDrowsinessFatigueLightheadednessLoss of consciousnessHigh or low blood pressureMuscle twitchesTiny pupilsSpasms of the stomach and intestinesWeaknessWeak pulse
It can be difficult to know what these products actually contain and the potential effects these substances may have. Always talk to your doctor before using such products, since even herbal ingredients can lead to potentially serious interactions and side effects.
Tolerance, Dependence, and Withdrawal
Codeine is a habit-forming opioid pain reliever, which means taking more than prescribed can easily lead to dependence and potentially addiction. It is possible to build a tolerance to purple drank, which puts you at a greater risk for overdose as well.
How Long Does Purple Drank Stay in Your System?
How long promethazine with codeine cough syrup will remain in your body depends on several factors, including dosage, how often you use the medication, your age, weight, and metabolism, as well as your hydration and activity levels. While there is no exact drug test or timeline for purple drank, here is an estimated detection window for codeine according to drug test type:
Urine: 2 to 3 daysBlood: Up to 24 hoursSaliva: 1 to 4 daysHair follicle: Up to 2 to 3 months (but will not register until 2 to 3 weeks after use)
Addiction
Developing an addiction to purple drank is possible—but it won’t happen overnight. Factors like genetics, environment, underlying mental health as well as the frequency of use all play a role in whether or not someone develops an addiction.
Withdrawal
If someone builds a tolerance to sizzurp and then suddenly stops taking it, they may experience symptoms of withdrawal, including:
AnxietyChills or goosebumpsDiarrheaFaster heartbeatIrritabilityLoss of appetiteMuscle achesNausea and vomitingRunny noseSleep problemsSweatingTeary eyesYawning
Withdrawal from purple drank use can be very uncomfortable, but it is not life-threatening. However, complications can occur that pose a potential danger. For example, vomiting and diarrhea can cause dehydration as well as chemical and mineral disturbances in the body. Overdose is also possible if someone quits and then takes the same dose of the drug again. Their body will no longer be able to tolerate the amount they used to take.
How to Get Help
If you or a loved one is misusing cough syrup, please seek help. Consult with a primary care physician, nurse practitioner, or mental health professional who can refer you to an addiction specialist. You may need long-term recovery support or addiction treatment to stay off this drug cocktail, including: For more mental health resources, see our National Helpline Database.
Inpatient treatment Intensive outpatient treatment Life skills training Maintenance medication Outpatient therapy Relapse prevention Support groups (Narcotics Anonymous or SMART Recovery)
Remember: There’s no shame in getting help; it’s one of the bravest things you can do.
